The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of "Major Recommendations" field.
The following recommendations are based on good and consistent scientific evidence (Level A):
- Emergency contraception should be offered or made available to women who have had unprotected or inadequately protected sexual intercourse and who do not desire pregnancy.
- The levonorgestrel-only regimen is more effective and is associated with less nausea and vomiting; therefore, if available, it should be used in preference to the combined estrogen-progestin regimen.
- The 1.5-mg levonorgestrel-only regimen can be taken as a single dose.
- The two 0.75-mg doses of the levonorgestrel-only regimen are equally effective if taken 12-24 hours apart.
- To reduce the chance of nausea with the combined estrogen-progestin regimen, an antiemetic agent may be taken 1 hour before the first emergency contraception dose.
- Prescription or provision of emergency contraception in advance of need can increase availability and use.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Treatment with emergency contraception should be initiated as soon as possible after unprotected or inadequately protected intercourse to maximize efficacy.
- Emergency contraception should be made available to patients who request it up to 120 hours after unprotected intercourse.
- No clinician examination or pregnancy testing is necessary before provision or prescription of emergency contraception.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- No data specifically examine the risk of using hormonal methods of emergency contraception among women with contraindications to the use of conventional oral contraceptive preparations; nevertheless, emergency contraception may be made available to such women.
- Clinical evaluation is indicated for women who have used emergency contraception if menses are delayed by a week or more after the expected time or if lower abdominal pain or persistent irregular bleeding develops.
- Information regarding effective contraceptive methods should be made available either at the time emergency contraception is prescribed or at some convenient time thereafter.
- Emergency contraception may be used even if the woman has used it before, even within the same menstrual cycle.
Definitions:
Grades of Evidence
I Evidence obtained from at least one properly designed randomized controlled trial
II-1 Evidence obtained from well-designed controlled trials without randomization
II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Levels of Recommendation
Level A - Recommendations are based on good and consistent scientific evidence.
Level B - Recommendations are based on limited or inconsistent scientific evidence.
Level C - Recommendations are based primarily on consensus and expert opinion.
